Hootan Zandifar, MD

The main reason we wait about 1 year between grafts is that some of the hair follicles that were transplanted would not start to grow until 1 year after transplant. By waiting we ensure that we don't accidentally damage these dormant follicles and allow you to get the most density possible. If the locations of the graft are different then you can have procedures closer to each other but if the location of the grafts overlap then I highly recommend that you wait.

Based on your pictures and your story, I believe you are a good candidate for an FUE. Because you had an FUT before, your donor site density should not be low and thus we can get 3000-3500 FUEs with little difficulty. Now that should give you better coverage and in the front better density. I do, however, think that you should still go on Finasteride either oral or topical because if you don't in 3 years you will likely be in this same place.

Those are all great questions. Based on your pictures you are a great candidate for hair transplant. You have plenty of donor hair and you will get great results. Generally to get the right density in an area that doesn’t have hair (your recessing temples) you need a fair amount of hair. So I would recommend around 2000 grafts with about 1000 on each side to achieve a high density look. You are correct to worry about what will happen to the remaining hairs as you age. Some of this will have to do with your family history of hair loss. That is one of the predictors of your hair loss pattern. If your parents, siblings, grandparents or aunts and uncles have history of hair loss, then it is likely you will continue to lose hair. The good news is that you can mitigate this by doing a few things starting now. First, you should ensure you have good hair hygiene. Don’t wear too tight of a cap or helmet regularly and don’t use any caustic material in your hair. Second, you will continue to benefit from minoxidil and Finastride. In my practice, I will genetic test you to see if these meds are the best options for you from your genetic results or not. If not we would adjust accordingly. Third, you may want to consider PRP treatments to your hair bearing areas. PRP can strengthen your current hair and decrease the likelihood of further hair loss. Finally, there are hosts of supplements that you can take to strengthen your hair and improve density. I like the products made by Simone Thomas Wellness. With long term planning, you can have a successful hair transplant today and enjoy it for a lifetime.

The very likely cause of your hair loss is the skin conditions that you have. The inflammation from both SK and Psoriasis can cause the hair follicles to fall. In most cases this is reversible with control of the underlying condition. Typically a topical steroid shampoo or topical steroid gel can be applied to the area to control the inflammation. This should reverse the hair loss and after a period of 6 months to a year the hair should regrow. Unfortunately, there are some cases where the hair doesn't regrow. In these instances, you may consider getting PRP treatment to the area to help with hair density or if the recession is sever enough you may consider hair transplantation. But the first thing that must be done is to control the inflammatory disease conditions that have caused the issue at the first place.

There is no difference with a first or second hair transplant. Any newly transplanted hair can start growth at 6 month but can be delayed until 1 year. You are still early in the process and it is very likely that over the next few months you will start to see hair growth. I would wait until at least a year. In the meanwhile you can have PRP injections done to the area where hairs were transplanted. In my patients, PRP treatment at the time of the transplant and even after transplantation greatly improves the rate of hair growth.